FDA approval given for new prostate cancer imaging technique

This new imaging method has been called a “game changer” and could become the new standard of care.

A new imaging technique for prostate cancer that locates cancer lesions in the pelvic area and other parts of the body to which the tumors have migrated has just been approved by the FDA.

The technique is known as prostate-specific membrane antigen PET imaging, or PSMA PET. This technique uses positron emission tomography in conjunction with a PET-sensitive drug that is highly effective in detecting prostate cancer throughout the body. This means that it can be better and more selectively treated. The PSMA PET scan also identifies cancer that is often missed by current standard-of-care imaging techniques.

It is now possible to provide a more effective imaging test for men who have prostate cancer. Because the PSMA PET scan has proven to be more effective in locating these tumors, it may eventually become the new standard of care for men who have prostate cancer, for initial staging or localization of recurrence.

How the new imaging technique works

For those patients who are initially diagnosed with prostate cancer or who were previously treated but who have experienced a recurrence, one critical step is to understand the extent of the cancer. Medical imaging is used to locate cancer cells so they can be treated.

PSMA PET works using a radioactive tracer drug, which is injected into the body and attaches to proteins known as prostate-specific membrane antigens. Because the prostate cancer tumors over-express these proteins on their surface, it allows the tracer to enable physicians to pinpoint their location.

As of late 2020, UCSF and UCLA are the only two medical centers in the U.S. that can offer PSMA PET to the public through this FDA approval. However, more hospitals will have the opportunity to adopt the technology, but only after applying for expedited FDA approval

Prostate cancer patients can benefit greatly from exercise post-treatment

The therapies and procedures that prostate cancer patients go through can have a negative effect on their physical capabilities to complete normal activities of daily living. Side effects of treatments can include: fatigue, loss of muscle mass, increased body fat percentage and perceived decline of function of daily activities. A great way fight against these unwanted side effects is by exercising.

In one recent study 155 men were randomly assigned to either a control group (no exercise intervention) or a 12-week exercise program including resistance training three days per week. The men in the group who participated in exercise reported less frequency and less severity of fatigue from normal activities of daily living. These same men also demonstrated increases in upper body and lower body muscular strength and endurance.

Resistance exercise has been widely reported as having beneficial effects on increasing muscle mass, muscle strength and muscle endurance in prostate cancer patients. It is also known to have positive effects on maintaining bone and connective tissue health which may help men reduce their risk of injuries while exercising and in everyday life.

It is highly recommended that men talk with their doctor or other health care provider before starting an exercise routine. The guidance of a fitness professional with certifications and experience working with the sub-specialty of cancer survivorship is also very helpful.

Question: How long can surgery for high-risk prostate cancer be safely delayed?

According to a study published in 2020, prostate cancer surgery for patients with high-risk disease can be safely delayed up to six months following diagnosis.

Because of the COVID-19 pandemic there have been widespread delays in medical treatments, including for cancer. The delays in surgery for low-risk prostate cancer have been found to result in minimal harm to the patient.

Unfortunately, however, there has been a lack of data regarding the association between surgical delay time with clinical outcomes in patients with localized, high-risk prostate cancer.

In this recent study, researchers used data from the US National Cancer Database to identify 32,184 patients with clinically localized high-risk prostate adenocarcinoma who were diagnosed between 2006 and 2016 and who received radical prostatectomy, or the removal of the prostate gland and surrounding tissues.

The surgery delay time (SDT) was defined as the number of days between initial cancer diagnosis and prostate cancer surgery, and was categorized into five groups: 31-60, 61-90, 91-120, 121-150, and 151-180 days. The primary outcomes were adverse pathological outcomes following surgery, including pT3-T4 disease, pN-positive disease, and positive surgical margin. The secondary outcome was overall survival.

When compared with an SDT of 31 to 60 days, longer SDTs were not associated with higher risks of any adverse outcomes (odds ratio 0.95; 95% confidence interval [CI] 0.80-1.12; P=0.53). An SDT of 151 to 180 was not associated with worse overall survival (hazard ratio 1.12; 95% CI 0.79-1.59; P=0.53). These same researchers also performed subgroup analysis for patients with very high-risk disease and found similar results.

The conclusion that the researchers reached was that in this large, contemporary cohort study of 32,184 patients with clinically high-risk localized prostate cancer who underwent radical prostatectomy within 180 days of diagnosis, increased SDT was not associated with higher risks of adverse pathological features or lower OS. Therefore, they concluded that radical prostatectomy for high-risk prostate cancer could be safely delayed up to 6 months after diagnosis.

Blood Test Could Make Early Detection of Cancer Possible

In the future an experimental blood test could make early detection of cancer possible. Two research studies published in 2020 show exciting advances in DNA methylation analysis, which is a method that examines biochemical alterations of genetic material for the presence of cancer.

Called “liquid biopsies” by some researchers, one of the experiments accurately predicted the emergence of 50 cancers and detected the area where the tumor was growing in thousands of people. The other experiment made predictions up to four years before symptoms occurred. The existence of a single test that can potentially screen for multiple cancers at once could be a huge breakthrough and lead to early interventions and treatments that save lives.

Early Detection of Cancer

A handful of cancer screening tests already exist. Mammograms look for early signs of breast cancer, colonoscopies check for colon cancer and Pap tests screen for cervical cancer. Undergoing these types of tests before symptoms appear can make a difference.

Unfortunately, all of these current cancer screening tests return an unacceptably high rate of false positives. A study, showed that over a period of 10 years 10 to 12 in 100 men screened for prostate cancer have false-positive results.

These new approaches currently being researched could provide accurate and early detection of cancer long before abnormal tissue or cells appear.

DNA Methylation Analysis

This type of early cancer detection could be possible because of a biochemical process, called methylation, which is the transfer of four atoms — one carbon atom and three hydrogen atoms (CH3) – from one substance to another. This transfer to and from substances work as a kind of biological switch, turning on and off a host of systems in the body. Because this process occurs in tens of millions of known places in the body, it has the potential to offer a global view of cancer.

This research showed that up to four years before the study subjects walked into the hospital, there were already signatures in their blood that showed they had cancer.

Although much more research is needed, DNA methylation analysis could fundamentally change cancer treatment. When taken into consideration that caner t is the second leading cause of death worldwide, the progress marks one of the most exciting possibilities in the early detection of cancer.

Vanished or hidden prostate cancer and the outcomes

An important question in prostate cancer is “Can early-stage prostate cancer “vanish” during follow-up?”

It seems more likely that the cancer is just “hidden”–either way, negative biopsies during active surveillance for prostate cancer are associated with excellent long-term outcomes, reports a study in The Journal of Urology®

For men undergoing active surveillance, negative biopsies indicate low-volume disease and lower rates of disease progression. These ‘hidden’ cancers can have excellent long-term outcomes and remain ideal for continued active surveillance.

Excellent long-term outcomes with negative biopsies on active surveillance have been noted

During active surveillance, prostate cancer is carefully monitored for signs of progression through regular prostate-specific antigen (PSA) screening, prostate exams, imaging, and repeat biopsies. The goal is for men to be able avoid or delay treatment-related side effects without compromising such long-term outcomes as cancer progression or survival.

In some cases, men undergoing active surveillance have negative biopsies showing no evidence of prostate cancer. And while these patients may believe their cancer has “vanished,” they most likely have low-volume or limited areas of prostate cancer that were not detected in the biopsy sample.

To evaluate the long-term significance of negative biopsies, researchers recently analyzed 514 men undergoing active surveillance for early-stage prostate cancer at UCSF between 2000 and 2019. All these patients had at least three surveillance biopsies after their initial prostate cancer diagnosis (total four biopsies). The median follow-up time was nearly ten years.

Thirty-seven percent of these patients had at least one negative biopsy during active surveillance, including 15 percent with consecutive negative biopsies. The men with negative surveillance biopsies had more favorable clinical characteristics, including low PSA density and fewer samples showing cancer at the initial prostate biopsy.
The negative biopsies were also associated with good long-term outcomes. At 10 years, the rates of survival with no need for prostate cancer treatment (such as surgery or radiation) were 84 percent for men with consecutive negative biopsies, 74 percent for those with one negative biopsy, and 66 percent for those with no negative biopsies. After adjusting for other factors, men with one or more negative biopsies were much less likely to have cancer detected on a later biopsy.

However, having negative biopsies didn’t mean that the cancer had “vanished” – even some men with consecutive negative biopsies later had positive biopsies or were diagnosed with a higher stage of cancer. Therefore, surveillance, although less intense, is still recommended rather than “watchful waiting” for men in good health. Higher PSA density and suspicious findings on prostate magnetic resonance imaging (MRI) scans were associated with a higher risk of cancer detected on later biopsies.

Negative surveillance biopsies in men on active surveillance indicate low-volume prostate cancer with very favorable outcomes. A less-intensive surveillance regimen should be supported in these patients after discussion of risks and benefits, particularly in those with low PSA density and adequate MRI-targeted sampling.

The importance of exercise for prostate cancer patients

Patients who have been diagnosed with prostate cancer often wonder whether they can exercise during — and after — their treatment. The answer, in both cases, is an emphatic yes. Physical activity can help patients live longer, improve their quality of life and help alleviate some of the side effects of prostate cancer therapies.

In general, it is always beneficial for prostate cancer patients to have an exercise regimen and for the majority of men they are completely physically able to participate as long as patients don’t overdo it.

Exercise has positive effects for prostate cancer patients

More than 3 million men are currently living with prostate cancer, a cancer that develops in the small, walnut-sized gland located below the bladder and in front of the rectum. It’s one of the most common types of cancer in America; about 1 in 9 men will develop the disease at some point in their lives, according to the American Cancer Society.

Research shows that for people who have prostate cancer, exercise can reduce the risk of dying from any cause. That research, published February 2011 in the Journal of Clinical Oncology, also found that vigorous exercise can lower the risk of dying from prostate cancer itself — men who did at least three hours of vigorous activity a week were 61 percent less likely to die of prostate cancer than people who did less than one hour a week.

More recently, a January 2016 European Urology study followed people with prostate cancer for up to 17 years and found that, among those who survived at least two years, the patients who were more physically active after diagnosis lived longer.

Exercise also helps protect against other health issues including heart disease, which can occur in people who have prostate cancer or have had it in the past, according to the American College of Cardiology.

Exercise is also recommended for people with prostate cancer who are doing “active surveillance,” i.e., monitoring their cancer closely with regular blood tests, rectal exams and biopsies. This is mostly because exercise has been shown to be helpful for prostate cancer in general. At this time, it’s still unclear whether exercise can help keep prostate cancer from progressing. Experts think that exercise may aid in preventing prostate cancer recurrence if it leads to weight loss for people who are overweight or obese.

Researchers identify indicators predicting lethal outcomes in high grade prostate cancer

Prostate cancer is one of the most common cancers among men in the United States; one in nine men will be diagnosed during his lifetime. When they are diagnosed, a patient’s disease is graded from 1 to 5 based on how aggressive it is, with 5 being the most aggressive.

Patients with grades 4/5 disease are at the highest risk of poor outcomes or death from the disease; however, there are no immunologic or genomic indicators that can help physicians determine the best course of treatment for this group of patients.

Moffitt Cancer Center researchers are hoping to change that. The team conducted studies to determine if genomic heterogeneity in tumors from grade 4/5 prostate cancer patients can be exploited to identify patient subsets that are at higher risk for lethal outcomes and therefore may benefit from targeted treatment strategies.

The studies from these researchers focused on transcriptomic interactions between the tumor immune content score and the Decipher score, a 22-gene classifier that provides a score predicting the probability that cancer will spread. They analyzed data from 8,071 prostate cancer patient samples of any disease grade (6,071 prostatectomy and 2,000 treatment naïve) in the Decipher Genomics Resource Information Database (GRID) registry. Each of the patient sample swas also given an immune content score (ICS) that was derived using the mean expression of 264 immune cell-specific genes.

All T=the samples were separated into four distinct immunogenomic subsets based on their results: ICS high/Decipher high, ICS low/Decipher high, ICS high/Decipher low and ICS low/Decipher low. These researchers discovered that approximately 25% of all grade 4/5 patient samples were in the ICS high/Decipher high subset.

The ICS high/Decipher high patient samples were further evaluated for the association between immunogenomic subtypes and radiation response signatures and they found that the ICS high/Decipher high subset were genomically more radiosensitive, meaning these tumors would respond well to radiation therapy. They determined that this subset also had a higher abundance of T cells and monocyte/macrophages. However, the research team says further research is needed to unravel the biologic mechanisms of this association.

These results will aid in the subtyping of aggressive prostate cancer patients who may benefit from combined immune-radiotherapy modalities.

The search for the prostate cancer treatment right for you

A prostate cancer diagnosis always brings with it great emotional stress for patients and their families. Choosing a treatment plan can be daunting. Questions arise like what treatment options exist, and what options are right for each patient and their specific diagnosis.

No matter what the cancer status, it is important to remember that no matter whether your cancer was caught early, or if found in Stage IV; patients do not need to feel alone.

Organizations such as ZERO – The End of Prostate Cancer (the nation’s leading nonprofit in the fight against this awful disease) have resources, support, and education materials to help all men determine the best treatment path.

In order to make a good decision about treatment options, patients should feel free talk with their urologist, oncologist, and other members of their medical team.

Different stages mean different treatment options

If a patient in the early stage he may be directed to active surveillance instead of pharmaceutical or surgical treatments. In cases like these a doctor simply monitors the cancer through regular tests to watch for signs that the cancer may be spreading or becoming more aggressive.

If a man has a cancer that is at risk of spreading, surgery, cryotherapy, radiation, or other treatments may be recommended to prevent the cancer from growing. Some patients may also have the option of hormonal therapies, which work in different ways to stop or inhibit the actions of the male hormones (androgens), such as testosterone, which fuel prostate cancer growth.

If a patient has advanced cancer he may be facing metastatic castration-resistant prostate cancer (mCRPC). They also may be eligible for immunotherapy, which uses immune cells (white blood cells) to attack advanced prostate cancer.

As of 2020, advanced prostate cancer patients now have the option of PARP inhibitors, thanks to the recent FDA approvals of Rubraca and Lynparza. PARP inhibitors are designed to disable DNA repair pathways in cancer cells, which make it difficult for cancerous cells to survive or populate.

NBA legend who is prostate cancer survivor talks about inequities in healthcare

Basketball legend Kareem Abdul-Jabbar recently opened up about his private battle with prostate cancer since being diagnosed 11 years ago.

The NBA’s all-time leading scorer revealed how he’s had prostate cancer, leukemia and heart bypass surgery. He is sharing his story in order to shed light on the health challenges facing black people.

While he’s received some of the best medical attention over the years as an NBA star, he’s aware of how others in the Black community do not.

In an essay, Abdul-Jabbar pointed out that some of the health issues black people are prone to as a group include diabetes, heart problems, obesity and cancer.

According to the U.S. Department of Health and Human Services Office of Minority Health African Americans have the highest mortality rate of any racial group for all cancers combined, and have higher rates of diabetes, hypertension and heart disease than other groups. This trend is continuing with COVID-19, which Abdul-Jabbar highlighted in his essay.

Abdul-Jabbar pointed out how more black people are dying from COVID-19 at higher rates because they are essential workers.

Based on data from several states, the coronavirus pandemic has hit Black and Latino communities across the U.S. hard, killing people of color at a disproportionate rate compared to white Americans.

The fact that people of color have more face-to-face jobs with people, they are more likely to be involved in healthcare, and they have to use public transportation. Those factors in and of themselves will make the people of color more susceptible, more vulnerable to a pandemic.

New drug research for prostate cancer may also aid in fighting COVID-19

Two women from the QUT Faculty of Health’s School of Biomedical Science, are developing drugs to fight advanced prostate cancer that could also prevent and or treat acute respiratory distress syndrome (ARDS).

Dr. Lisa Philp and Professor Colleen Nelson and their research team, based at the Translational Research Institute, realized their research on two hormones secreted by body fat, that modulate prostate cancer tumor growth could also have roles in driving the rapid-onset, severe lung inflammation that kills patients with serious COVID-19 disease.

The research team had been investigating two novel drugs that target fat hormones, one hormone which is pro-inflammatory, and another hormone that has an anti-inflammatory effect; each of which is involved in the progression of prostate cancer.

Using their data and knowledge of COVID-19 research the team came to the hypothesis that these drugs could be effective treatments for ARDS.

The team had been collaborating with two US-based biotech companies to advance their research on the drugs to a phase 1 clinical trial in prostate cancer patients. They have very strong data that both these drugs suppress tumor progression in advanced treatment-resistant prostate cancer and, importantly, inflammation.

The good news is the San Francisco company working on this drug has already used it in patients with inflammatory eye conditions, so we know it is safe for human use. In fact, the company is developing it for other illnesses such as liver disease.

The team had been working with this company in the prostate cancer context but when COVID hit we said to them that it could be a great treatment for ARDS. The company is supporting us financially to be able to get through these proof of principle pre-clinical studies.